FORMULIR PENDATAAN ULANG

GERAKAN MAHASISWA NASIONAL INDONESIA

(GmnI)
Fakultas Hukum Universitas Kristen Indonesia

Saya yang bertanda tangan dibawah ini bersedia mengikuti acara Pekan Penerimaan Anggota
Baru Fakultas Hukum Universitas Kristen Indonesia:

Nama Lengkap : .....................................................................................................

Nama Panggilan : .....................................................................................................
Tempat, Tanggal Lahir : .....................................................................................................
Alamat : .....................................................................................................
No. Telp/Hp  : .....................................................................................................
Fakultas : .....................................................................................................
Jurusan : .....................................................................................................
Angkatan : .....................................................................................................
Nama Orang Tua : .....................................................................................................
Alamat Orang Tua : .....................................................................................................
Riwayat Pendidikan :
SD _: ____________________________________________Tahun Lulus_____________________
SLTP _: ____________________________________________Tahun Lulus_____________________
SLTA _: ____________________________________________Tahun Lulus_____________________
Pengalaman berorganisasi : 1. ................................. 2......................................................
Saya mengikuti GmnI, karena............................................................................................................
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Dengan ini bersedia mengikuti Pekan Penerimaan Anggota Baru Gerakan Mahasiswa Nasional
Indonesia Fakultas Hukum Universitas Kristen Indonesia. Demikian pernyataan ini saya perbuat.

Jakarta, 20…
Hormat Saya,
foto 3x4

(BUNG/SARINAH…..…………………………………..)